Uterine fibroids are one of the most common gynecological conditions, yet many women have questions about what they are, how they develop, and when they need treatment. Although fibroids can sound alarming, the good news is that they are almost always benign, meaning they are not cancer. Still, fibroids can affect women in different ways, from causing no symptoms at all to significantly impacting quality of life.
What Are Uterine Fibroids?
Uterine fibroids, also called leiomyomas or myomas, are noncancerous growths that form in or on the uterus. They develop from the muscular tissue of the uterus and can vary greatly in size, shape, and location. Some fibroids remain very small and go unnoticed, while others grow large enough to distort the size and shape of the uterus.
Fibroids can grow inside the uterine cavity, within the uterine wall, or on the outer surface. In some cases, they attach to the uterus by a thin stalk, called a peduncle. Women may have just one fibroid or multiple growths that vary in size. Growth patterns also differ. A fibroid may stay small for years, grow slowly over time, or enlarge more quickly.
Who Is at Risk for Fibroids?
Fibroids can occur at any age, but they are most commonly diagnosed in women during their 30s and 40s. Studies have shown that African American women are more likely to develop fibroids, often at a younger age, and sometimes with larger or faster-growing tumors. Family history can also play a role, as fibroids can run in families.
Pregnancy may also affect fibroid size. Some fibroids grow during pregnancy due to increased hormone levels, while others may shrink or remain stable.
Recognizing the Symptoms
One of the challenges with fibroids is that they do not always cause noticeable symptoms. Some women only learn they have fibroids during a routine pelvic exam or ultrasound performed for another reason. Others, however, may experience symptoms that interfere with their daily lives.
Possible signs of fibroids include heavy or prolonged menstrual bleeding, painful periods, and spotting between cycles. Excessive bleeding can sometimes lead to anemia, which may cause fatigue or dizziness. Fibroids can also cause pressure or pain in the pelvis, lower back discomfort, or pain during intercourse.
Depending on their location, fibroids may press on the bladder or rectum, leading to frequent urination, constipation, or difficulty with bowel movements. In some cases, fibroids can contribute to pregnancy complications, miscarriages, or difficulties with fertility.
Possible Complications
Although fibroids are almost always noncancerous, they can still cause problems. A fibroid that is attached by a stalk may twist, causing sudden pain, nausea, or fever. Fibroids that grow rapidly or begin to break down can also cause discomfort. Very large fibroids may enlarge the abdomen, making it difficult for a provider to perform a thorough pelvic exam.
Fibroids have been associated with infertility in some women, though they are not the most common cause. When fibroids are suspected to affect fertility, treatment may improve the chances of becoming pregnant.
How Fibroids Are Diagnosed
Fibroids are often discovered during a pelvic exam, when a provider feels that the uterus is enlarged or irregularly shaped. Imaging tests can confirm the diagnosis and provide more detail about size and location.
Ultrasound is the most common method used to visualize fibroids. In some cases, a saline infusion sonogram, also called sonohysterography, can provide more detail about the inside of the uterus. Other diagnostic tools include hysteroscopy, which uses a thin camera inserted through the cervix to view the uterine cavity, and laparoscopy, which allows a provider to view the outside of the uterus through a small incision near the belly button.
Less commonly, MRI or CT scans may be used to evaluate fibroids, especially if surgical planning is needed or if the diagnosis is uncertain.
Do All Fibroids Require Treatment?
Not every fibroid requires treatment. If fibroids are small, not causing symptoms, or nearing menopause, many women can simply monitor them with regular exams. Treatment is usually recommended when fibroids cause significant symptoms, such as heavy or painful periods, anemia, pelvic pain, infertility, or rapid growth.
Medical Management Options
Several medications can help manage the symptoms of fibroids. Hormonal birth control, including pills, patches, and intrauterine devices, may reduce heavy bleeding and painful periods. A progestin-releasing IUD can be particularly effective for women with fibroids that do not distort the uterine cavity, as it helps control bleeding even though it does not treat the fibroids themselves.
Gonadotropin-releasing hormone (GnRH) agonists can temporarily stop the menstrual cycle and shrink fibroids, often making surgery safer. However, these medications are not meant for long-term use. Tranexamic acid is another option used during menstrual cycles to help control heavy bleeding.
While medications can ease symptoms, they typically do not eliminate fibroids altogether.
Surgical and Procedural Treatments
For women who need more definitive treatment, surgery or other procedures may be considered. A myomectomy involves surgically removing fibroids while leaving the uterus intact. This option is often chosen by women who wish to preserve fertility. New fibroids may develop in the future, but many women achieve long-term relief after a myomectomy.
A hysterectomy, or removal of the uterus, is a permanent solution for fibroids and eliminates the possibility of recurrence. This option is generally recommended when other treatments have not worked or are not possible, or if a woman no longer wishes to have children.
Other less invasive procedures may also help. Hysteroscopic resection removes fibroids from the inside of the uterine cavity during an outpatient procedure. Uterine artery embolization cuts off the blood supply to fibroids, causing them to shrink. MRI-guided focused ultrasound is a newer technique that uses high-intensity ultrasound waves to destroy fibroid tissue, though ongoing research is evaluating its long-term effectiveness.
Living with Fibroids
Fibroids affect women in different ways. Some may live for years with no symptoms, while others struggle with daily discomfort or difficulty conceiving. The most important step is to work closely with your OB/GYN to monitor fibroids and decide on treatment when needed.
Bloom OB/GYN: Helping You Navigate Fibroid Care
Our team provides comprehensive care, from diagnosis to treatment, and helps each patient find the approach that fits her individual needs. Whether that means monitoring fibroids over time, managing symptoms with medication, or exploring surgical options, we are here to guide you every step of the way.
If you have symptoms of fibroids or want to learn more about your options, schedule an appointment with Bloom OB/GYN today. Our team is ready to provide compassionate, expert care tailored to your needs.
